=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770921082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE BELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2013
-----------------------------------------------------
Last Update Date | 01/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6948 TIA CT
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27360-8941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-554-1835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6948 TIA CT
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27360-8941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-554-1835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5006249
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 195882
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------